Surviving The Pressure to Diet, Part I

For adults and children, the concept of dieting or restricting eating for health reasons is commonplace and even considered healthy. A part of modern day living is to constantly monitor and reconsider which foods should be eaten and which avoided. Our general appetite for more nutrition news is seemingly insatiable. 

Unfortunately, when these studies are fully evaluated, it's clear that they do not represent trustworthy science. There is no regulation of this information, and anyone is allowed to impart their own personal wisdom as fact in a new book, diet or food fad. 

The result is a world where it is virtuous to follow any diet without considering the validity of the recommendations or the health of the suggestions. Even the medical field tends to be unclear as to how to change eating behaviors since doctors themselves have minimal training in nutrition. 

Diets rarely consider some basic facts about our bodies, nutrition or metabolism. We focus mostly on calories and ignore other critical pieces of information such as essential items of nutrition necessary for healthy body function. We don't take into account the variety of foods necessary for general health. We also do not consider that changes in metabolism almost always, in countless studies, lead to a reversal in weight loss from every diet. How can a society supposedly grounded in science be so willing to forgo reason and diet incessantly when all evidence points to failure?

Therein lies the confusion. We all diet when reliable data points to its failure. We even encourage or turn a blind eye to dieting children until a real problem, such as an eating disorder, presents itself. 

A final issue is that all this dieting has increased the incidence of eating disorders significantly in the last forty years, yet no one seems to acknowledge this change. 

Three pieces of information can help explain why an entire society continues to make the irrational decision to diet without even considering the consequences: the desire for thinness at all costs and as a panacea for our daily woes; the collective panic over endless supplies of processed, irresistible food; and the total lack of protection by industry or regulatory agencies from the massive change in available foods in recent decades. 

I have written about these concerns in this blog before, and nothing has changed in recent years. This post serves as a bridge between the risks of starvation and the ways to combat the societal pressure to diet. The next post will focus on ways to rethink and revise our thoughts about dieting. 

The Risks of Dieting and Starvation

The model in the last post described a three step process to explain the cause of an eating disorder: genetic predisposition, environmental trigger and emotional/psychological stimuli. Although the first and third part of the model increase the likelihood greatly of illness, there is no chance an eating disorder will occur without the trigger of starvation. 

It remains somewhat controversial to view dieting and undereating as a necessary part of the evolution of an eating disorder. Dieting and losing weight are seen as a beneficial and even health-promoting parts of modern life. The increased concern over obesity and the incessant focus on thinness make dieting a cornerstone of our daily life. Dieting has become the de facto answer to many medical ills. 

Yet no one speaks of the medical risks of dieting and chronic starvation. Various diets of 1200 calories per day, half of which often comes from a shake made of processed protein powder, are commonplace. Starving all day in order to wait and eat at night is considered virtuous. The diet industry is a booming business. 

This message seeps down to children and adolescents who easily fall into the trap of dieting and soak up the praise that comes with weight loss while nobody seems to worry about the risks associated with a malnourished child. 

The immediate risks, including lack of energy, slowed thinking or weakened organ function, do not come to mind when we think about a diet. Instead weight loss is blindly equated with health.

But dieting also triggers ingrained biological adaptations to starvation, the body's protection against times of famine. The adaptations include obsessive thoughts about food and weight, slowed metabolism to conserve energy and the preservation of essential body functions at the expense of less necessary ones. The basic functions include cardiovascular function, maintenance of core temperature and basic organ function but sacrifices muscle mass, higher level brain function and reproductive capability. It's like the body running on a backup generator. 

This metabolic shift is the key to the illness model. It is the trigger. If someone rests in starvation metabolism for too long, they run the risk of triggering a longterm, adaptive shift into starvation metabolism, essentially a semi-permanent state to survive famine. In modern life, this mental and physical shift isn't based on actual famine. The food is still all around us. But starving for long enough can trigger the thoughts of an eating disorder if someone is so predisposed. That is the central risk. 

When dieting was not pervasive in our culture, this risk was minimal, but recent decades have made dieting almost a rite of passage. All of a sudden, we all are exposed to this risk, we all try to diet and starve at some point, we all test to see if we have a genetic predisposition to an eating disorder. And we all do this without any understanding of the risk we are taking.

Instead when a child or adolescent turns out to have an eating disorder, the general consensus is to throw up our hands in confusion, but the number one risk for developing an eating disorder is that first step to start a diet.

The implications of what this knowledge means for adults and children will be the focus of the next post.

The Causes of an Eating Disorder

Patients, parents, family and friends find solace in asking how an eating disorder starts. Often what makes an eating disorder last is more important for treatment than why it started, but figuring out the initial cause does two important things: creates a story that helps someone make sense of their lives and provides underlying clues for therapy. 

I have written at length about the number one cause of an eating disorder: dieting and starvation. Taking in significantly less food than one needs for an extended period of time triggers the innate human response to famine. Metabolism slows, organs function efficiently but less effectively, unnecessary body function is sacrificed. If this time persists, brain changes occur which include decreased cognitive function, obsessive focus on food and increased attention to body shape and weight. The number one reason for the skyrocketing incidence of eating disorders in recent decades is widespread sanctioned dieting, especially in children and adolescents. 

The second cause for an eating disorder is genetic predisposition. Not all kids and people who diet end up with an eating disorder. In fact, the large majority don't, even if many of them stay focused on food and weight into and through adulthood. A certain percentage of people have an innate response to eating disorder symptoms, largely a strong biological and seemingly chemical response to the eating disorder symptoms. Prolonged starvation, binging or purging can all trigger powerful chemical responses in the brain that are very calming and, for those are predisposed, almost addictive. In addition, the rigid rules and routine of an eating disorder create calm and safety not as an immediate response but as a longterm salve to the uncertainty of daily life. People who combine the trigger of starvation with the powerful biological response to the behaviors are at higher risk for an eating disorder. 

The third component of the cause of an eating disorder is emotional. Kids who lack love, warmth and attention feel as if they have found a panacea in an eating disorder. The almost magical trick of having figured out food--whether through prolonged starvation or a method of eating and purging l--and the positive feedback of being thin replace the emotional pain of feeling unloved and worthless. This experience can range from seemingly benign neglect to emotional or physical abuse to traumatic experiences. The severity of the experience tends to correlate to how much the emotional cause contributes to the eating disorder. 

These three components of the cause of an eating disorder do not factor in equally. For some the genetic component is the main instigator of the eating disorder and for some a traumatic childhood is. For most though, the eating disorder started because all three potential reasons came together in such a way that led to the person falling into this illness.

Most people find comfort in having an explanation as to why their eating disorder started. This conversation can be hard but it helps push aside the shame associated with the illness and give the person enough agency to continue taking steps in recovery.